An expanded EDC policy

Global EDC Policy with Endocrine Science

The Endocrine Society has redoubled its efforts to bring endocrine expertise to the global policy arena on the issue of endocrine-disrupting chemicals (EDCs). With members from approximately 120 countries, the Endocrine Society is a global organization with the expertise and capacity to address this global scientific and public health issue. Through a strategic initiative that expands its base of experts engaged in policy work and further positions the Society as a resource for policymakers worldwide, the Society has established two new task forces with distinct but complementary goals. This new infrastructure provides connectedness and continuity to the Endocrine Society’s efforts not only to promote awareness among policy makers but to gain a better understanding of the research and education needs in different regions of the world.

On March 31 and April 1, the Society’s European Union (EU) EDC Task Force convened in Brussels, Belgium, to meet with EU policy makers to discuss ongoing processes to define and regulate EDCs. Comprising endocrine experts from key EU countries, the Task Force works to ensure endocrine principles are incorporated into EDC regulatory policies. During this trip, Task Force members met with members of the European Parliament (MEPs) — elected officials representing individual countries — to raise awareness of EDCs. They also met with officials from the European Commission Directorates General (DG) in charge of research and of chemicals laws and regulations. The European Commission is the EU’s executive body and represents the interests of Europe as a whole. The work of the European Commission is accomplished through the policy-relevant DGs, or departments, which are classified according to the policies they address and through services, which deal with more general administrative issues or have a specific mandate.

The Commission is in the process of examining EU chemicals legislation and preparing to establish criteria for defining endocrine disruptors, making this a critical time for policy makers to hear from endocrine experts who have a unique and integral perspective on the science of EDCs. Co-chaired by R. Thomas Zoeller, PhD (USA), and Jean-Pierre Bourguignon, MD PhD (Belgium), the EU EDC Task Force members hail from France, Germany, Italy, and the United Kingdom. Task Force members are Barbara Demeneix, PhD, DSC; Richard Ivell, PhD; Josef Koehrle, PhD; Adriana Maggi, PhD; GianCarlo Panzica, PhD; and Remy Slama, PhD.

Task Force members met with MEP Sirpa Pietikainen (Finland) and with staffof MEP Michele Rivasi (France) to discuss the importance of EDCs in human health and the environment. MEPs Pietikainen and Rivasi have shown leadership on this issue and welcomed the Society’s engagement in the EU process. Scientific details were discussed with officials from DG Research and Innovation, DG Health and Consumers, DG Enterprise and Industry, and DG Environment. The Society will continue to engage these officials to advance knowledge and understanding of EDCs and to ensure the endocrine perspective is considered in policy decisions.

To facilitate the advancement of knowledge, ICE/ENDO 2014 features a Meet-the-Director workshop in which attendees can learn from Laurent Bocherau, PhD, about scientific priorities and funding opportunities from DG Research and Innovation (Saturday, June 21, 2014, 2:30 PM – 3:15 PM, W475).

While the EU EDC Task Force focuses its efforts on communicating with leaders in the EU, which has in place a well developed mechanism for chemicals regulations, the global policy picture is less developed, requiring a different approach. The Endocrine Society has taken steps also to address the needs on the global stage, particularly in developing countries and countries with economies in transition.

The new Global EDC Policy Task Force (GEPTF) will implement a strategy of education and awareness-raising that will reach policy makers and other audiences worldwide. The GEPTF has members from each of five global regions as defined under the Strategic Approach to International Chemicals Management (SAICM), a policy framework to promote chemical safety around the world. SAICM states its overall objective as the achievement of the sound management of chemicals throughout their life cycle so that, by 2020, chemicals are produced and used in ways that minimize significant adverse impacts on human health and the environment. More than 150 stakeholder groups participate in SAICM, including the chemical industry, non-governmental organizations, and more than 100 governments. The GEPTF is co-chaired by the EU EDC Task Force cochairs, and its members are Tania Bachega, MD, PhD (Brazil); Riana Bornman, MD, DSc (South Africa); Noriyuki Koibuchi, MD, PhD (Japan); Patricia Joseph-Bravo, PhD (Mexico); and Djuro Macut, MD, PhD (Serbia).

During its inaugural meeting at the Society’s Washington, D.C., headquarters on April 22, the GEPTF began to lay out its overall strategy, focusing primarily on achievable outcomes in 2014. Task Force members agreed that a primary activity will be to communicate the Society’s scientific messages to SAICM stakeholders and other interested parties. To aid in this endeavor, the Society is collaborating with International POPs Elimination Network (IPEN) to produce and distribute a policymakers’ guide to EDCs, which is expected to be completed sometime this summer. The guide’s content is being written entirely by a team of Endocrine Society experts, led by Andrea Gore, PhD, with the IPEN reviewing the language for the target audience and distributing the finished product to relevant stakeholders. Rounding out the Society writing group are David Crews, PhD; Heather Patisaul, PhD; Michele La Merrill, PhD; and Ami Zota, PhD. GEPTF members will be instrumental in disseminating the guide and raising the Society’s profile on the global stage, as they will share the guide’s content in educational activities and discussions with SAICM participants and others.

2014 is a pivotal year in global action on EDCs, with crucial decisions being made and important activities initiated across the globe. The Society’s strategic investment in education, awareness-raising, and influence will potentially have far-reaching and long-lasting impact on the science and regulation of chemicals that interfere with hormone action. Society members’ knowledge and expertise, coupled with the Society’s organizational capacity, will inform the global debate through broad dissemination of accepted endocrine principles and cutting-edge endocrine research. By taking leadership in this pressing public health issue, the Society also is demonstrating the central role of endocrinology and endocrinologists in protecting the environment and human health. Society members are the world’s leading experts in endocrinology, and by bringing that expertise to bear on important public health issues, the Society is helping to improve the health and well being of generations to come.

— Doan, PhD, is the director of science policy at the Endocrine Society.

Q&A with Glenn Matfin, MD, editor,
Endocrine and Metabolic
Medical Emergencies

By Mark A. Newman

An endocrine emergency flummoxes many general practitioners, not to mention ER doctors who may not be very well versed in these often complex disorders. To that end, the Society’s book publishing arm, The Endocrine Press, has just published Endocrine and Metabolic Medical Emergencies to provide practitioners with a wealth of information on a variety of endocrine emergencies.

“Whether in the emergency room, critical care unit, or on the inpatient floor, acute and chronic diseases can perturb the endocrine system, having important implications for testing, diagnosis, and treatment,” says J. Larry Jameson, MD, PhD, dean, Perelman School of Medicine, University of Pennsylvania, who also wrote the book’s foreword. “It is useful for trainees and practitioners to have access to a resource that addresses these practical and common clinical scenarios.”

The massive tome is well over 400 pages and is edited by Glenn Matfin, MD, a consultant physician in the UK’s National Health Service. Endocrine News reached out to Matfin to discuss this exciting book, which will undoubtedly become a must-read for practitioners regardless of specialty.

Endocrine News: What inspired you to come up with the concept of a book about Endocrine and Metabolic Medical Emergencies?

Glenn Matfin: Acute medical care is a major focus for many healthcare providers and funders. Patients with endocrine and metabolic emergencies constitute a large proportion of this clinical workload. Unfortunately, many patients are not ideally managed due to the lack of excellent, up-to-date, and practical guidance. The purpose of this book, Endocrine and Metabolic Medical Emergencies, is to help fill this gap by updating and collating existing knowledge on the management of numerous everyday endocrine and metabolic emergencies facing clinicians everywhere. We believe that this book will bring the topic areas upto-date, set a standard for diagnosis and treatment in each category, and comprehensively cover the area.

Why do you think this book is important for the Endocrine Society to publish?

GM: There is an unmet need for a comprehensive clinician resource covering acute endocrine and metabolic emergencies. As the Endocrine Society is a world leader in education and translation of clinical endocrinology, it is understandable that this unmet need be addressed by the Endocrine Society. The chosen medium for this clinician resource is book format with both paper and electronic versions.

In addition, the timing for the concept of this book proposal coincided with the establishment of Endocrine Press as the publishing arm of the Endocrine Society. Endocrine and Metabolic Medical Emergencies is the first book produced wholly by this new group and has been a useful learning exercise for all involved. These learnings will enable the Endocrine Society to successfully publish many more important titles and impact both basic and clinical endocrine knowledge leading to better patient care.

What is the biggest challenge in treating endocrine and metabolic emergencies for clinicians and hospitalists?

GM: Sir Richard Thompson (president of the Royal College of Physicians in the United Kingdom), and the distinguished endocrinologist, John Wass, state in the book that there is a crisis in acute medical care for multifarious reasons, including rising acute medical admissions, increasingly older and frailer patients with complex illnesses and multiple comorbidities, systemic failures of care, poor patient experience, and a medical workforce crisis. This provides the context within which endocrine and metabolic emergency care occurs.

However, despite the challenges, many opportunities exist for delivering high-quality, patient-centered, costeffective care. One of these challenges is to translate knowledge about common (and not so common) endocrine and metabolic emergencies to improve clinical care. Larry Jameson writes in the Foreword to the book that “this text expands the repertoire of traditional endocrine emergencies to myriad other conditions that require urgent attention to optimize clinical outcomes.”

What do you think are some of the biggest misconceptions about emergency endocrine and metabolic treatments?

GM: Many clinicians (especially junior doctors and nonendocrine specialists) believe that patients presenting with various emergency endocrine and metabolic disorders must be treated to “normal” values as quickly as possible. It is almost a “badge of honor” to rapidly correct the abnormal value (e.g. level of glucose, sodium, osmolality, anion gap, blood pressure) to “normal” levels. This practice can lead to increased morbidity and mortality. Preventing rapid and over-correction by education, guidelines, and other resources (such as this book) can reduce unnecessary suffering and potentially save lives.

Who is the ideal audience for this book?

GM: Endocrine and Metabolic Medical Emergencies is certain to prove a valuable resource that will benefit endocrinologists and other clinicians (including internists, acute care, critical care, and hospitalists). All levels of expertise (junior doctors, mid-level practitioners, and even established professors) will find that this clinical resource will help close important knowledge gaps and that this will translate to improved patient care.

You state in your Preface that the way the book is structured makes it easy for the reader to tackle the subjects they are most interested in first and read about other topics at a later time. What was your thinking behind assembling this book so that each chapter stands on its own?

GM: The rationale is that endocrine emergencies can present to the clinician in no particular order and at any time. They each require specific investigations and management, which is covered in the specific chapter.

Ideally, more generic aspects of acute medical care and the impact of acute medical and critical illness on endocrine investigations and management can be read in the early sections prior to reading the rest of the book.

What do you think will surprise endocrinologists and general practitioners most about this book?

GM: The diversity of topics covered. The earlier sections focus on the initial management of acute medical illness, the effects of acute medical and critical illness on the endocrine and metabolic systems, and the impact of these changes and other factors on endocrine investigations in this setting. Several special populations of patients are also discussed including the unique impact of aging, pregnancy, and HIV/AIDS on emergent endocrine and metabolic disorders presentation and management. The remaining sections cover various different endocrine and metabolic systems including pituitary, thyroid, adrenal; calcium, phosphate, and metabolic bone diseases; neuroendocrine tumors; glucose; sodium; obesity and clinical lipidology; and inherited metabolic disorders.

In addition, some of the thorny issues that are especially taxing to the clinician or areas not so often addressed in publications (such as the management of insulin pumps or U-500 insulin in the inpatient setting) are covered.

The excellence and geographical representation of the authors will also surprise many readers. We have key leaders of numerous societies represented in the authorship (including current presidents, past-presidents, and presidents-elect). We also have many authors who have been involved in developing national and international guidelines in the areas related to their chapter content.

What did you learn after your experience with Endocrine and Metabolic Medical Emergencies?

GM: This is a full-time job!

Many different stakeholders are involved in taking an initial concept through to successful book publication. Effective teamwork and project management is critical in this process and the Endocrine Press team and publishers met the challenges to achieve this goal.

Last but not least, I was humbled by the tremendous effort by the authors. Despite very tight deadlines and having numerous other commitments, they generously shared their time and expertise in writing the excellent chapters.

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